Feasibility and safety of total extraperitoneal inguinal hernia repair after previous lower abdominal surgery: a case-control study.

BACKGROUND: This study aimed to evaluate the feasibility and safety of totally extraperitoneal (TEP) endoscopic hernia surgery after previous lower abdominal surgery, which may preclude preperitoneal dissection.

METHODS: All 331 consecutive patients undergoing TEP surgery between January 2008 and December 2010 were included in a prospective cohort study. This case-control study included a study group and a comparison group. The study group consisted of 23 patients with a history of previous lower abdominal surgery before undergoing TEP endoscopic hernia repair. For the comparison group, 46 patients were randomly selected (two for every patient in the study group) and matched with the study cohort in terms of age, gender, and laterality of inguinal hernia. Perioperative data were obtained for all the patients including demographic data, operation time, length of hospital stay, narcotic dose, conversions, and complications.

RESULTS: A total of 69 patients with inguinal hernias underwent TEP surgery: 23 patients with previous abdominal surgery (study group) and 46 patients without such surgery (control group). No conversions were necessary in the control group, but one case (4.4%) in the study group was converted to transabdominal preperitoneal hernia repair (TAPP) (P = 0.33). Peritoneal injury requiring intracorporeal repair was encountered in six study group patients and eight control group patients (P = 0.53). No differences were observed between the two groups in terms of operative times, analgesic use, hospital stay, return to daily activities, or postoperative complications.

CONCLUSIONS: In experienced hands, TEP hernia repair for patients with previous lower abdominal surgery can be performed safely. In this study, the operative outcomes were comparable with those for patients who had no history of lower abdominal surgery.